High Use of Estrogen-based Contraceptives in Young Women With Inflammatory Bowel Disease in the United States
Authors: Erica J. Brenner, Xian Zhang, Millie D. Long, Marla C. Dubinsky, Michael D. Kappelman
Journal: Clinical Gastroenterology and Hepatology (2023)

Inflammatory bowel disease (IBD) and estrogen-based contraceptives both increase thromboembolism risk,1Limdi J.K. et al.Inflamm Bowel Dis. 2019; 25: 1603-1612Crossref PubMed Scopus (14) Google Scholar leading some gastroenterologists to recommend that women with IBD avoid estrogen-based contraceptives when possible, regardless of age.2Mahadevan U. et al.Gastroenterology. 2019; 156: 1508-1524Abstract Full Text Full Text PDF PubMed Scopus (193) Google Scholar,3Truta B. Current Opinion in Gastroenterology. 2021; 37: 306-312Crossref PubMed Scopus (6) Google Scholar However, these recommendations are based on data largely from women with IBD older than age 25,4Peragallo Urrutia R. et al.Obstet Gynecol. 2013; 122: 380-389Crossref PubMed Google Scholar,5Yuhara H. et al.Aliment Pharmacol Ther. 2013; 37: 953-962Crossref PubMed Scopus (151) Google Scholar and the absolute risk of thromboembolism increases substantially with age.6Curtis K.M. et al.MMWR Recomm Rep. 2016; 65: 1-103Google Scholar No prior studies have evaluated contraception use or safety specifically among women with IBD aged 15–25. Accordingly, pediatric IBD preventive care resources omit contraception,7DeFilippis E.M. et al.Pediatrics. 2016; 138e20151971Crossref PubMed Scopus (29) Google Scholar and adult IBD contraceptive recommendations do not address the unique needs of young women.2Mahadevan U. et al.Gastroenterology. 2019; 156: 1508-1524Abstract Full Text Full Text PDF PubMed Scopus (193) Google Scholar Young women in general tend to prefer estrogen-based contraceptives8Kavanaugh M.L. et al.F S Rep. 2020; 1: 83-93Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar because they are easily accessible, decrease dysmenorrhea, and alleviate menstrual-related IBD symptoms better than alternatives.9Gawron L.M. et al.Inflamm Bowel Dis. 2014; 20: 1729-1733Crossref PubMed Scopus (31) Google Scholar Although long-active reversible contraceptives (LARCs), including the intrauterine device (IUD) and the implant, are safe, well-tolerated, and recommended as first-line in IBD,2Mahadevan U. et al.Gastroenterology. 2019; 156: 1508-1524Abstract Full Text Full Text PDF PubMed Scopus (193) Google Scholar many young women simply are not comfortable using them or cite cost concerns.10Todd N. et al.Journal of Clinical Research in Pediatric Endocrinology. 2020; 12: 28-40Crossref PubMed Scopus (39) Google Scholar Progestin-only pills often cause irregular bleeding and must be taken at the same time every day, and the progestin-based injectable may cause bone loss.1Limdi J.K. et al.Inflamm Bowel Dis. 2019; 25: 1603-1612Crossref PubMed Scopus (14) Google Scholar,3Truta B. Current Opinion in Gastroenterology. 2021; 37: 306-312Crossref PubMed Scopus (6) Google Scholar,10Todd N. et al.Journal of Clinical Research in Pediatric Endocrinology. 2020; 12: 28-40Crossref PubMed Scopus (39) Google Scholar Because of these factors, the extent to which young women with IBD and their providers adhere to recommendations to avoid estrogen-based contraceptives remains unknown. Accordingly, we evaluated contraceptive use patterns among young female contraceptive users with IBD and compared them with contraceptive users from the general population. We conducted a case-control study using longitudinal pooled health data from the IQVIA PharMetrics Plus Adjudicated Claims Database between January 1, 2014 and December 31, 2018. Inclusion criteria were (1) female sex, (2) ≥1 prescription contraceptive claims between ages 15–25, and (3) ≥6 months of continuous insurance enrollment before the index date. We identified estrogen-based prescription contraceptive use (cases; includes the estrogen-based oral contraceptive pill, patch, and ring) and non–estrogen-based contraceptive use (controls; includes the progestin-only pill, injectable, implant, and IUD) according to the first prescription contraceptive identified during enrollment between the ages of 15 and 25. We defined the index date as the date this prescription occurred. We then looked backward within 6 months before the index date to assess the independent (exposure) variable of IBD diagnosis, defined as detailed in Supplementary Methods. All covariates were assessed within 6 months before the index date, and we excluded subjects with ≥1 claims for hysterectomy or sterilization during this period. We performed bivariate comparisons by IBD status. We used multivariable logistic regression to determine adjusted odds ratios (aORs) with 95% confidence intervals of estrogen-based prescription contraceptive use (versus non–estrogen-based) by IBD status, adjusting for U.S. region, insurance type, age, and non-IBD comorbidities and medications associated with increased contraceptive risk. See Supplementary Methods for complete statistical analysis plan. We identified 802,932 young women on contraceptives, of whom 1083 had IBD. The mean age was 20.5 ± 3.0 years across the entire cohort. Age and U.S. region were similar across IBD status. Among young women with IBD, 63% had Crohn's disease, 36% had ulcerative colitis, and 1% had IBD unclassified. The majority of young women with IBD (45%) were on a biologic therapy, followed by mesalamine (33%) and immunomodulators (26%). More women with IBD had commercial insurance, and fewer had commercially managed Medicaid when compared with young women without IBD (84% vs 75%, 13% vs 22%, respectively). A minority of individuals (2%) had non-IBD comorbidities that have been associated with an increased risk of contraceptive side effects, although a relatively higher percentage was seen among young women with IBD versus without IBD (9% vs 2%). Hypertension, rheumatoid arthritis, and valvular heart disease were the most common non-IBD comorbidities across the cohort. Few individuals were on non-IBD medications associated with an increased risk of contraceptive side effects, although a slightly higher percentage was observed among those with IBD versus those without IBD (4% vs 2%). Overall, 73% of young women on prescription contraceptives used estrogen-based contraceptives. The percentage was similar when stratified by IBD status, with 72% of young women with IBD and 73% of young women without IBD using an estrogen-based contraceptive. Use of an estrogen-based pill, patch, and ring was similar for women with IBD versus without IBD (68% vs 69%, 3% vs 3%, 2% vs 1%, respectively). Women with IBD had a slightly higher proportion of implant use and similar IUD use versus those without IBD (16% vs 14%, 2% vs 2%, respectively; Figure 1, Supplementary Table 1). After adjustment, the odds of estrogen-based contraceptive use were 0.88 (95% confidence interval, 0.76–1.01) for young women with IBD compared with those without IBD. Despite the recommendation for LARC over estrogen-based contraceptives in women with IBD, 72% of young female contraceptive users with IBD in the United States still use estrogen-based contraceptives. There was a small and non-significant trend toward lower estrogen-based contraceptive use among those with IBD compared with those without IBD. Our study has limitations. Because we only evaluated individuals with commercially managed insurance, the study inadequately represents the uninsured and those with federally funded insurance. Young women who change or lose insurance coverage may be incompletely captured. This issue may be particularly relevant for LARC methods, which can be used for ≥3 years, but any underestimate of LARC use likely occurred with similar frequency across exposure groups. To mitigate exposure misclassification, we used a conservative definition of IBD with multiple claim requirements. We restricted our analysis to contraceptive users because contraceptive subtype choice was our primary focus rather than prevalence of contraceptive use vs non-use, and the percentage of individuals with a contraceptive indication likely differs by IBD status. In conclusion, the high use of estrogen-based contraceptives among young women with IBD suggests the need for gastroenterologists to discuss contraception with their young female patients with IBD, particularly as they transition to adult care and take greater responsibility for their healthcare, and for rigorous safety studies specific to this population. If future studies demonstrate that these methods are relatively safe for young women with IBD, the gastroenterology community can update disease-specific contraception recommendations to condone current contraceptive use patterns. Conversely, if further investigation indicates that estrogen-based contraceptive use confers an unacceptably high risk in young women with IBD, future quality improvement and patient-centered educational efforts will be needed to change contraceptive use patterns in this population. The statements, findings, conclusions, and opinions contained and expressed in this manuscript are based in part on data obtained under license from the IQVIA Legacy PharMetrics Adjudicated Claims Data, All Rights Reserved. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IQVIA or any of its affiliated or subsidiary entities. The authors obtained a license from Adobe StockTM to use the artwork included in the graphical abstract. Supplementary Table 1Demographics, Contraceptive Methods, and Disease Characteristics of Women in the United States Aged 15–25 Using Prescription Contraceptives, Stratified by Inflammatory Bowel Disease StatusYoung women with IBDYoung women without IBDP valueaBivariate comparisons performed by using the χ2 or Fisher exact test for categorical variables and the t test or Wilcoxon rank-sum test for continuous variables.N, medianSD, %N, medianSD, %N1083N/A801,849N/AAge (y) Mean20.72.8420.52.95.003 Median21.018.0, 23.021.018.0, 23.0.004IBD diagnosisN/AN/AN/A Crohn's disease68463.2% Ulcerative colitis39136.1% IBD unclassified80.7%Contraceptive method used (n, %).143bP value for contraceptive method use across all categories. Estrogen-based77771.7%588,09473.3%.235cP value compared with non–estrogen-based methods.Pill73267.6%551,53668.8%.397Patch292.7%25,1423.1%.388Ring161.5%11,4161.4%.882 Non–estrogen-based30628.3%213,75526.7%Pill494.5%28,8143.6%.100Injection635.8%58,0457.2%.071Implant17416.1%113,49914.2%.071IUD201.8%13,3971.7%.652U.S. region.004 Northeast25523.5%172,14821.5% North Central31829.4%211,84026.4% South22520.8%178,88622.3% West24022.2%209,37626.1% Unknown454.2%29,5993.7%Insurance type<.001 Commercial90583.6%599,42674.8% Medicaid14313.2%173,51821.6% Self-insured171.6%18,5882.3% SCHIP20.2%21880.3% Medicare Risk20.02%2160.0% Medicare Cost00.0%110.0% Unknown141.3%79021.0%IBD medicationN/AN/AN/A Biologic83444.5% Mesalamine/sulfasalazine41838.6% Immunomodulator27625.5% Calcineurin inhibitor10.1% Mycophenolate10.1% Oral budesonide1059.7% Tofacitinib00.0%Non-IBD comorbiditiesdNon-IBD comorbidities and medications were selected if they fell in the Center for Disease Control's United States Medical Eligibility Criteria for Contraceptive Use6 category 3 or 4 for any prescription contraceptive. Breast cancer00.00%1210.02%.686 Cardiovascular disease, other262.40%66570.83%<.001 Cardiomyopathy10.09%2530.03%.261 Cervical cancer10.09%3400.04%.425 Cirrhosis50.46%880.01%<.001 Diabetes with complication00.00%5360.07%.395 Deep vein thrombosis161.48%7570.09%<.001 Endometrial cancer00.00%150.00%.887 Gestational trophoblastic disease00.00%1000.01%.713 Hypertension292.68%73470.92%<.001 Ischemic heart disease50.46%4830.06%<.001 Liver tumors00.00%130.00%.895 Malabsorptive bariatric surgery90.83%200.00%<.001 Migraine with aura90.83%200.00%<.001 Multiple sclerosis20.18%2810.04%.009 Pelvic inflammatory disease20.18%2810.04%.009 Primary thrombophilia30.28%6380.08%.022 Pulmonary embolism00.00%2600.03%.553 Rheumatoid arthritis171.57%12180.15%<.001 Solid organ transplantation10.09%1780.02%.122 Stroke60.55%6980.09%<.001 Systemic lupus erythematosus60.55%8820.11%<.001 Tuberculosis10.09%1540.02%.083 Valvular heart disease70.65%16590.21%.001Number of non-IBDcomorbiditiesdNon-IBD comorbidities and medications were selected if they fell in the Center for Disease Control's United States Medical Eligibility Criteria for Contraceptive Use6 category 3 or 4 for any prescription contraceptive.<.001 098290.67%782,44297.58% 1726.65%16,5362.06% 2201.85%23180.29% 3+90.83%5530.07%Non-IBD medicationsdNon-IBD comorbidities and medications were selected if they fell in the Center for Disease Control's United States Medical Eligibility Criteria for Contraceptive Use6 category 3 or 4 for any prescription contraceptive. Butalbital141.29%27780.35%<.001 Carbamazepine00.00%4000.05%.462 Fosamprenavir00.00%00.00%— Lamotrigine111.02%51970.65%.132 Oxcarbazepine20.18%10660.13%.641 Primidone00.00%510.01%.793 Pentobarbital00.00%00.00%— Phenobarbital20.18%3760.05%.037 Phenytoin00.00%840.01%.736 Rifabutin00.00%30.00%.949 Rifampin20.18%770.01%<.001 Secobarbital00.00%00.00%— Topiramate141.29%46970.59%.002No. of non-IBD medicationsdNon-IBD comorbidities and medications were selected if they fell in the Center for Disease Control's United States Medical Eligibility Criteria for Contraceptive Use6 category 3 or 4 for any prescription contraceptive.<.001 0104196.12%788,07898.28% 1393.60%12,8681.60% 230.28%8530.11% 3+00.00%500.01%N/A, not applicable; SCHIP, State Children's Health Insurance Program; SD, standard deviation.a Bivariate comparisons performed by using the χ2 or Fisher exact test for categorical variables and the t test or Wilcoxon rank-sum test for continuous variables.b P value for contraceptive method use across all categories.c P value compared with non–estrogen-based methods.d Non-IBD comorbidities and medications were selected if they fell in the Center for Disease Control's United States Medical Eligibility Criteria for Contraceptive Use6Curtis K.M. et al.MMWR Recomm Rep. 2016; 65: 1-103Google Scholar category 3 or 4 for any prescription contraceptive. Open table in a new tab Supplementary Table 2Healthcare Claims Codes by SubtypeCategorySubcategoryNDC codesICD-9 and ICD-10 codesHCPCS codesInflammatory bowel disease subtypeCrohn's diseaseN/A555, K50N/AInflammatory bowel disease subtypeUlcerative colitisN/A556, K51N/AInflammatory bowel disease medicationBiologics00074379902, 00074379903, 00074379906, 00074433902, 00074433906, 00074433907, 00074634702, 00074937402, 54868482200, 50474070062, 50474071079, 50474071081, 57894007001, 57894007002, 57894007101, 57894007102, 57894035001, 57894003001, 59075073015, 64406000801, 64764030020, 578940054, 578940060, 578940061N/AJ0135, J0717, J0718, C9249, J1602, J1745, Q5102, Q5102, J2323, Q4079, J3380, C9026, J3357, J3358Inflammatory bowel disease medicationMesalamine/sulfasalazine00013010101, 00013010111, 00013010120, 00013010201, 00013010220, 00013010501, 00023585318, 00032192428, 00032192482, 00032192824, 00032192846, 00037002207, 00037006603, 00037006605, 00037686010, 00054007928, 00054007929, 00093688871, 00149075202, 00149075206, 00149075215, 00149078301, 00378675082, 00430075227, 00430075327, 00430078327, 00574725003, 00591079601, 00591079605, 00591079610, 00591357035, 00603580104, 00603580121, 00603580128, 00603580132, 00603580321, 00603580325, 00677048301, 00677048305, 00904115240, 00904115260, 23490509003, 38779001204, 38779001205, 38779001208, 38779017604, 38779017605, 38779017608, 38779017609, 43353049553, 43353049570, 43353049580, 43353088479, 43386051087, 45802009828, 45802009851, 45802092341, 45802092349, 49452045001, 49452752301, 49452752302, 49999096918, 50268010213, 50474060001, 50474060025, 50532006603, 50532006605, 51552030205, 51552104405, 51927104500, 51927107800, 52544079601, 52544079605, 53014072671, 53014072682, 53489014701, 53489014705, 54092018980, 54092018981, 54092019112, 54092019180, 54092047602, 54092047612, 54569031303, 54569479300, 54868112301, 54868113801, 54868113900, 54868251500, 54868251501, 54868251502, 54868251503, 54868251504, 54868251505, 54868485500, 54868519900, 54868530200, 54868530201, 54868531400, 54868614700, 54868615000, 55289017640, 55289083330, 58016007490, 58914050018, 58914050056, 58914050118, 58914050142, 58914050156, 59762010401, 59762010402, 59762500001, 59762500002, 60505257507, 62559042007, 62991100901, 62991270403, 62991270501, 62991270502, 62991270503, 63370015035, 65649010102, 65649010150, 65649010202, 65649010302, 66336050390, 66993095077, 67544054981, 67544054988, 67544054989, 67544094370, 67544094380, 68084079932, 68220002207, 68220002228, 68220006603, 68220006605, 68220006607, 68220006628, 68220016010, 68258912901, 68382048428, 68682075002N/AN/AInflammatory bowel disease medicationImmunomodulator00054408425, 00054808425, 00173059755, 00378100501, 00406200301, 00781507501, 23490511009, 38779031203, 38779031204, 38779031206, 43353068609, 43353068660, 43353074509, 43353074560, 49452078301, 49452078302, 51079062001, 51079062006, 51552077902, 51552077905, 51927225800, 52959007900, 54868092101, 54868092104, 54868531000, 54868531003, 54868531004, 57866902101, 60976059755, 62991218901, 62991218903, 63370002510, 65483059010, 65649023141, 65649024141, 66479030110, 66591022141, 66591023141, 66591024141, 68084022901, 68084022911, 68382000301, 68382000305, 68462050201, 69238107601, 55390060020,00054458111, 00054458127, 00093551006, 00173080725, 00378354725, 00378354752, 49884092202, 49884092204, 54868528200, 57844052206, 57844052207, 62484002001, 68084032511, 68084032521, 68258910301, 00364249901, 00536399801, 00781107601, 38779003504, 38779003506, 49452460002, 49452460102, 49452460104, 51552105401, 51552105409, 51927156500, 62991120001, 62991120002, 62991120004, 62991120005, 63370015410, 63370015415, 63370015425, 54436001002, 54436001004, 54436001502, 54436001504, 54436001704, 54436002002, 54436002004, 54436002502, 54436002504, 54436007504, 59137050504, 59137051004, 59137051504, 59137052004, 59137052504, 59137053004, 59137053504, 59137054004, 59137054504, 59137055004, 00005450723, 00054455015, 00054455025, 00054855025, 00069014601, 00069014602, 00069014701, 00069014702, 00069014801, 00069014901, 00069018102, 00069020410, 00186142013, 00205532526, 00378001401, 00378001450, 00555057202, 00555057235, 00555092701, 00555092801, 00555092901, 00555094501, 00703367101, 00703367103, 00703367191, 00703367193, 00703367301, 00703367501, 00703367591, 00703367801, 00904174960, 00904601260, 10019094101, 10139006202, 10139006210, 10139006240, 16729027703, 16729027730, 16729027735, 21695011100, 23490588900, 42254011030, 42291059401, 49999038024, 51079067001, 51079067005, 51285036601, 51285036701, 51285036801, 51285036901, 51285050902, 52959024400, 54868017300, 54868017301, 54868382600, 54868382601, 54868382602, 54868382604, 54868382605, 54868382606, 54868382607, 54868471600, 54868479600, 55289092430, 55390003110, 55390003210, 55390003310, 55390003410, 55390014301, 58406067105, 58406068114, 58406068117, 58406068316, 59911587401, 60429008036, 61703035010, 61703035038, 61703040807, 61703040841, 63323012102, 63323012104, 63323012108, 63323012110, 63323012140, 63323012250, 63323012302, 63323012310, 66479013501, 66479013509, 66479013611, 66479013613, 66479013619, 66479013721, 66479013929, 66758004001, 66758004002, 66758004008, 66758004101, 67253032010, 67253032036, 67457022102, 67457022110, 67457022140, 67457046610, 67457046721, 67457046799, 67457048040, 67457048599, 67457048699, 68115063200, 00005450704, 00005450705, 00005450791, 00054855003, 00054855005, 00054855006, 00054855007, 00054855010, 00555057245, 00555057246, 00555057247, 00555057248, 00555057249, 67253058042, 67253058043, 67253058044, 67253058045, 67253058046N/AJ7500, J7501, J8610, J9250, J9260Inflammatory bowel disease medicationCalcineurin inhibitor00078010901, 00078011022, 00078024015, 00078024115, 00078024161, 00574086610, 54868552200, 55390012210, 60432014050, 60505013300, 60505013400, 62584082711, 62584082721, 68084092125, 00074310832, 00074310932, 00074646332, 00074647932, 00074726950, 00078024615, 00078024661, 00078024815, 00078024861, 00078027422, 00093574019, 00093574065, 00093574165, 00093574265, 00172731000, 00172731046, 00172731100, 00172731146, 00172731200, 00172731246, 00172731320, 00185093230, 00185093330, 00591222215, 00591222315, 00591222455, 50111088542, 50111090943, 50111092043, 51862045847, 51862046047, 54868623200, 60505035401, 00078061605, 00078061705, 00078061805, 00378204501, 00378204505, 00378204601, 00378204605, 00378204701, 00378204705, 00469060767, 00469060773, 00469061710, 00469061711, 00469061771, 00469061773, 00469064773, 00469065710, 00469065711, 00469065773, 00469067773, 00469068773, 00469301601, 00591335901, 00781210201, 00781210301, 00781210401, 00781930201, 00781930301, 00781930401, 16729004101, 16729004201, 16729004301, 21695017000, 43353017809, 43353017853, 43353017860, 43353017880, 50742020701, 50742020801, 50742020901, 51079002801, 51079002820, 51079081701, 51079081720, 51079081801, 51079081820, 55111052501, 55111052601, 55111052701, 60429037701, 60429037801, 62175038037, 62175038137, 62175038237, 64380072006, 64380072106, 64380072206, 67544120553, 67544120560, 67544120580, 68084044901, 68084044911, 68084045001, 68084045011, 68084045101, 68258909901, 68992301001, 68992301003, 68992304001, 68992304003, 68992307501, 68992307503N/AJ7502, J7515, 80158Inflammatory bowel disease medicationMycophenolate00004025901, 00004025905, 00004025943, 00004026001, 00004026043, 00004026129, 00054016325, 00054016329, 00054016625, 00054016629, 00093733401, 00093733405, 00093733419, 00093733493, 00093747701, 00093747705, 00378225001, 00378225005, 00378447201, 00378447205, 00781206701, 00781206705, 00781206789, 00781517501, 00781517505, 16729001901, 16729001916, 16729009401, 16729009416, 21695017100, 49999093630, 49999093730, 51079037920, 51079072120, 59762070201, 59762070203, 59762070301, 60429005901, 60429005905, 60429007001, 60429007005, 60505296701, 60505296705, 60505296707, 60505296801, 60505296805, 60505296807, 60951073470, 60951073570, 60951073585, 64380072506, 64380072507, 64380072606, 64380072607, 67877022501, 67877022505, 67877023022, 67877026601, 67877026605, 68084017701, 68084017801, 68084017811, 68084058701, 68084058801, 68084079501, 68258905201, 68258907301, 68382013001, 68382013005, 68382013101, 68382013105, 68382013110, 00004029809, 00004029830, 00078038566, 00078038666, 00378420178, 00378420278, 51079050820, 51079050901, 51079050920, 60505296507, 60505296607, 68084090711, 68084090721, 68084091825N/AJ7517Inflammatory bowel disease medicationOral budesonide00093744501, 00186070210, 00378715501, 00378715505, 49884050101, 51079002001, 51079002003, 54868491000, 54868491001, 54868491002, 60429026401, 65483070210, 68012030930N/AJ7626, J7627, J7633, J7634Inflammatory bowel disease medicationTofacitinib000690501, 000691001, 635390012, 635390501N/AN/AHysterectomy or sterilizationHysterectomy or sterilizationN/A655, 656, 662, 663, 683, 684, 685, 686, 687, 688, 689, 6551, 6552, 6553, 6554, 6561, 6562, 6563, 6564, 6621, 6622, 6629, 6631, 6632, 6639, 6831, 6839, 6841, 6849, 6851, 6859, 6861, 6869, 6871, 6879, V25.2, V26.5, V26.51, V26.52, 618.5, V45.77, 65.5, 65.51, 65.52, 65.53, 65.54, 65.6, 65.61, 65.62, 65.63, 65.64, 66.2, 66.21, 66.22, 66.29, 66.3, 66.31, 66.32, 66.39, 66.5, 68.3, 68.31, 68.39, 68.4, 68.41, 68.49, 68.5, 68.51, 68.59, 68.6, 68.61, 68.69, 68.7, 68.71, 68.79, 68.8, 68.9, Z30.2, Z90.71, Z90.722, Z98.5, Z98.51, Z98.52, N99.358150, 58152, 58180, 58200, 58210, 58240, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58285, 58290, 58291, 58292, 58293, 58294, 58541, 58542, 58543, 58544, 58548, 58550, 58552, 58553, 58554, 58565, 58570, 58571, 58572, 58573, 58575, 58615, 58671, 58700, 58720, 58950, 58951, 58952, 58953, 58954, 58956, A4264ContraceptiveEstrogen-based pill70700012084, 68462030929, 00025026506, 65862094088, 00430054014, 00093531528, 69238153106, 59651002988, 68462055629, 52544053221, 50102023021, 68180089311, 68180084071, 50102022823, 00555901658, 51285011458, 00378730653, 69238155106, 16714046404, 50102023313, 54868050700, 00555901458, 52544052628, 54569628000, 50102015401, 51862047101, 50102022423, 50458019106, 00093214062, 00025008124, 00071091345, 00062179515, 35356036828, 75854060101, 70700011684, 68180088013, 35356001568, 00062133220, 54868474200, 00093603191, 00062133215, 68180087913, 69238155406, 00603760817, 00025027412, 54569555100, 50419041021, 35356047605, 54868436800, 00087057941, 50102012010, 51285009158, 00603760715, 59651003028, 68180083873, 52544095021, 50102022021, 69238103106, 54569535800, 00781406615, 16714040401, 50102012003, 50102022421, 68180084473, 54868477800, 51285054628, 00093807316, 50458025115, 00062125101, 00555903270, 00555906558, 54569645700, 52544093628, 68462073329, 51862031803, 16714036301, 00430053014, 54868482800, 16714034701, 00555904979, 00603763449, 00555902858, 68180089271, 68180085773, 54868503100, 52544027721, 00254203080, 16714036004, 68180088673, 00555900980, 00905027928, 16714036603, 00781565615, 00378728490, 54868535600, 68180085713, 00555906679, 68180088671, 54868042800, 68462038829, 68180088611, 54569579700, 00603752149, 00062178015, 00603760748, 00093209058, 51285012870, 00023603003, 52544084721, 54569534900, 51862000701, 00093313491, 00555904558, 68180086671, 69238103107, 00555902658, 68180083811, 59746076343, 00247100421, 51862028401, 00087057841, 68180089713, 51285008498, 00603760602, 52544026531, 52544026884, 00603760648, 51862051006, 54868474500, 00052026108, 00555902079, 52544063128, 00008007502, 68462067291, 16714040404, 54569579600, 75854060228, 68462031884, 54569471000, 68180086511, 00093807328, 52544025428, 00430053714, 00781405815, 52544022891, 00603760702, 00071092847, 00071091648, 54569427300, 52544029841, 23490771901, 00430058014, 50419041112, 00247100328, 51285012797, 51660057286, 75834011684, 54868379000, 00378731585, 54569654200, 68180084611, 16714037003, 52544051021, 68462050479, 00781410352, 17478026006, 00603764017, 00062190215, 68180089171, 51285012998, 50419041128, 50458019128, 00052028308, 00008253603, 00555905079, 42254027028, 00555900942, 51862004791, 00555902742, 50102022821, 50458017115, 68180086012, 00008253601, 00555903458, 68462031629, 51862002801, 00430058311, 52544029231, 00378730185, 00008111730, 00378730753, 00781558307, 16714036304, 68180084073, 51862026006, 51285001728, 68258597602, 68180091113, 68180084813, 00062178120, 68462085229, 54868491100, 00378728485, 00781558336, 00603754017, 70700012285, 00093330516, 35356001468, 65862084888, 54868459000, 53002156706, 00025016124, 65862084928, 54868395100, 52544098131, 50102024023, 16714036704, 16714034001, 50102012048, 68180088613, 59651003085, 50419040872, 68180091111, 54868486000, 51285057628, 54868532600, 00378729385, 68180089211, 54569645800, 50419043306, 54569643400, 52544005841, 00555901479, 00555900858, 00378729753, 52544027431, 00555904958, 00555905167, 65862093487, 16714040604, 68462073184, 63629266601, 53002157701, 00603761017, 00052028306, 00008253303, 00555904358, 00555901858, 70700011484, 68180086473, 00603764201, 54868502800, 00555901467, 00093214028, 54868050200, 50458025120, 50458019712, 68180088211, 16714036601, 68180084413, 00378728685, 51285007997, 21695077001, 68180089371, 51862003601, 51862004701, 16714035904, 51285008070, 00254203091, 53002156501, 65862094087, 51862047006, 50102013048, 00378728285, 42987010923, 68462050481, 00008251102, 68180089273, 00555901079, 51285043187, 00093531581, 00781406215, 24090080184, 68180084013, 00378729853, 65862093574, 52544017572, 00781557515, 68180091171, 00430058214, 54569067900, 70700012284, 00008251402, 51862001206, 50458017806, 52544024828, 42254024228, 51862047106, 68462056529, 16714036701, 00071091745, 50458019700, 52544023328, 50419040203, 68462071929, 55887034028, 52544095428, 50102023113, 68180083813, 65862077885, 68462031829, 00555900957, 00025008109, 65862077785, 00603752517, 52544084828, 52544021928, 68180086513, 00025015107, 17478026128, 00052026148, 00008253605, 55887031428, 00555906667, 51285008198, 50458017615, 42254026028, 23490994701, 50102012803, 00062179615, 35356037028, 68180084811, 70700011885, 00093542358, 23490756401, 00052028148, 68462041984, 53217009128, 70700012085, 00062191015, 00603762549, 68258594602, 65862093988, 00555906479, 50458019728, 51285051428, 54868044200, 17478026028, 65162034784, 65862093921, 54868474400, 54868423900, 68180083713, 68462072084, 00025025706, 68180090213, 52544005431, 00378729353, 52544094928, 50419040501, 00378728653, 68180089913, 51862009701, 68180083871, 54868616100, 68462073384, 52544027428, 00008091202, 50102015403, 51862054501, 35356025528, 00603754001, 51862007206, 00062178115, 68180086411, 68180086573, 68462063784, 50419040301, 54868409300, 00254203373, 51862056401, 00781406015, 52544026528, 35356036528, 68180088011, 50458025128, 00555902058, 00062190120, 52544029831, 51862031801, 54569579800, 68462039429, 52544050821, 51285008370, 50458017820, 51862056406, 35356041128, 00378728785, 54868485000, 00023586230, 51285012570, 68180087513, 51862028403, 65862077628, 51862029201, 00378728053, 52544006431, 65862077728, 54569669100, 54868593500, 54868270100, 16714037001, 50419040503, 53002157703, 68180089373, 54868485100, 51862009706, 21695076901, 00555904579, 68180085411, 54868044300, 68180083773, 00555906458, 52544094028, 52544029528, 00555901279, 68180086673, 68462039484, 16714040601, 68462072029, 60505418301, 00093566158, 00339651899, 00062176115, 50419040803, 65162031684, 00062190715, 52544098231, 68258597002, 52544008728, 00603359049, 54868404500, 54569499900, 50458019615, 00254203280, 00603760615, 52544063028, 70700011585, 70700011384, 51862051001, 00008251403, 50102013090, 50458019601, 68180089813, 00008253501, 50458019706, 51285009287, 65862084988, 00603751249, 00025025906, 00025016109, 68180086611, 52544096691, 54868473000, 00052026906, 54868260600, 53002156401, 00062178122, 00378730853, 00071091347, 70700011984, 21695085701, 65862086495, 00052026106, 00555905179, 3535603632